New hope for sufferers of hepatitis

The Ministry of Health and Population has signed an agreement with US pharmaceutical company Gilead Sciences to provide Sovaldi, a new hepatitis C virus (HCV) treatment, at a fraction of its cost in the US. A standard 12-week course of the drug costs $84,000 in the US. It is being made available to Egypt at just $900.

The drug will be available to HCV patients through Egypt’s 26 National Centres for Hepatic Viruses. By the end of September, 170,000 courses of the new medication will be available, initially through eight centres. By February 2015 an additional 55,000 courses will have been prescribed.

“Gilead Sciences has agreed to provide the drug at a 99 per cent discount on its US price on condition it is the only medication used for treating patients suffering from hepatitis C in Egypt’s government hospitals and clinics,” said Minister of Health and Population Adel Al-Adawi. Under the terms of the agreement Egypt will be resupplied with Sovaldi every six months.

The World Health Organisation (WHO) estimates that more than 150 million people are infected with hepatitis C. The vast majority of cases are in developing countries. Downstream complications from the virus include cirrhosis and liver cancer.

With 12 million of its 90 million population infected with HCV, Egypt has the highest rate of infection in the world. Each year 165,000 new cases are reported. The virus kills 40,000 Egyptians every year.

Sovaldi’s success rate with hepatitis C patients is over 95 per cent, says Tarek Hassanein, an Egyptian doctor at the University of California San Diego who was part of the research team that developed the new drug. “It has been tested against hepatitis C types 1, 4, 5 and 6. Patients with type 4 showed a success rate of 96 per cent.” Type 4 is the most common stain of the virus in Egypt.

Solvadi is of little benefit to patients already experiencing advanced symptoms of liver failure. Less critical cases, says Hassanein, respond well, and in the absence of further complications, often caused by weight gain, smoking and alcohol consumption, the liver is capable of repairing itself within five to seven years.

“Egyptian patients, in particular, are prey to quack cures. There are advertisements on the TV promoting herbal remedies that it is claimed stimulate the liver when in reality they harm it,” warns Hassanein.

Six out of ten new infections in Egypt are thought to be contracted in hospitals and clinics. Hairdressers and barbers are also possible sites of infection because the HCV can be spread through contact with already infected blood.

Egypt is working to improve training in infection control for doctors and nurses and to stamp out unsafe medical practices, including the reuse of needles and other medical equipment. But raising standards, says the head of the National Liver Institute, Wahid Doss, will require more funding. “The amount a dentist in a poor rural area earns from treating a patient,” he points out, “is unlikely to cover the cost of sterilising the equipment he uses.”

Increasing public awareness is key to reducing infection rates. A campaign is being developed, with UNICEF and WHO support, to inform the public of the dangers of sharing needles. “HCV is prevalent among intravenous drug users,” says Doss. “Addicts need to be targeted as part of any information campaign.”

In February Major General Ibrahim Abdel-Aati held a press conference to announce that a military medical team had developed a device capable of curing patients infected with HCV. Hopes of an immediate breakthrough were later dashed when, in June, it was announced that the device would need a minimum of six months further testing.

A target of 300,000 patients being treated annually with the new drug has been set, according to Ministry of Health spokesman Mohamed Fathallah. This contrasts with just 350,000 patients treated over the last six years using conventional therapies.

Doss has great hops for Sovaldi: “There is now a possibility that Egypt will be able to end HCV infection, using the new medication in conjunction with precautionary measures that reduce sources of contamination.”